Challenges for Sebelius and Obamacare

Last Friday, I was among a dozen people who sat privately to talk about the Affordable Care Act (ACA), aka Obamacare, with the embattled Health and Human Services Secretary, Kathleen Sebelius. Dressed in a light green blazer, sitting alongside Memphis Mayor AC Wharton and Congressman Steve Cohen, who had nudged her to visit Memphis, Secretary Sebelius listened to our feedback and shared her insights.

First and foremost, addressing the issue of the website, to us in the room and later to the crowd, the secretary said, "It's like the first quarter" of a football game, and we should not "declare it game over." As a life long football fan, I agree that we must not rush to judgment. In fact, I would expand the analogy further. The rollout is the kickoff in the first quarter of the first game of the first season. Many more seasons or enrollment periods will come for the ACA. And yes, the administration fumbled the ball on the kickoff with its website.

I had watched Secretary Sebelius being grilled in Washington by the Republican legislators. Many said that the website exemplifies the failure of Obamacare as a whole.

What is so ironic is that the very congressmen and women who were berating Sebelius due to ACA's website failure have been trying to repeal, replace and de-fund the ACA. At times I wonder, in their heart of hearts did the congressmen and women really want the website to work perfectly?

"It's politics," a colleague at the meeting tells me.

So if we look at the ACA beyond the politics, we, as Americans, realize there are many compelling challenges we face.

First, as people begin signing up, albeit in trickling numbers, we are recognizing that many lack health care literacy, especially as it relates to health insurance. People may understand terms like deductible, premium and co-pay. But few know the bronze, silver and platinum options or terms such as co-insurance. Even I had to refer to the glossary on the healthcare.gov website to learn that "Coinsurance is similar to copayment, except it's a percentage of costs you pay (instead of a fixed amount).

Another challenge has been to better understand why some privately insured individuals are having their coverage dropped, despite the President pledging "if you like your health insurance, you can keep it." A New Yorker magazine article looked at the "winners, losers and the unaffected" among the population as a whole with respect to insurance status due to ACA. The writer estimates that 80 percent of people will be unaffected, and 3 percent will have no real consequences but will have to buy new but similar plans. However 3 percent will be losers, in that they will have to buy a higher-quality plan (which provides the mandated 10 essential health benefits with no annual cap and may cost more), and 14 percent will be clear winners who will gain access to affordable health insurance.

A third challenge for the ACA has been how divisive it is to the American people. Despite the frustrations with the enrollment on the website, the public has been evenly divided between those who approve or disapprove of the program. However, if we look at those statistics closely, more than 10 percent of those who disapprove of the health law do so because they wanted a more liberal plan, such as a single payer or a public option.

In our meeting with the secretary, we brought up our greatest concern and challenge that the law poses for Tennesseans: the lack of Medicaid expansion and how the secretary could work with Governor Haslam. By one estimate, the Tennessee legislature and governor are leaving $300 million on the table every quarter that they decline to accept Medicaid expansion, such as the plan adopted by Arkansas. Each quarter, millions of Tennessean's tax dollars are siphoned to other states to pay for their Medicaid expansion, and hospitals like the Regional Medical Center and others are feeling the strain. The next step is for the governor to submit a plan to the secretary on how Tennessee may consider expanding Medicaid, and receive the additional Medicaid funding.

During our half-hour discussion, I closely watched the secretary to see if she seemed bitter, blaming or defensive. Instead, I found her to be genuinely regretful that the website has caused frustration to so many Americans. I think she was blind-sided by the complexity of the intersection of computers and health care. I can empathize with her; recently, I too was blind-sided and failed miserably -- and that was simply trying to implement an electronic medical system in my own office.